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Original Article
Volume 338:777-783 March 19, 1998 Number 12
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Hypovitaminosis D in Medical Inpatients
Melissa K. Thomas, M.D., Ph.D., Donald M. Lloyd-Jones, M.D., Ravi I. Thadhani, M.D., M.P.H., Albert C. Shaw, M.D., Ph.D., Donald J. Deraska, M.D., Barrett T. Kitch, M.D., Eleftherios C. Vamvakas, M.D., Ph.D., Ian M. Dick, M.Sc., Richard L. Prince, M.D., and Joel S. Finkelstein, M.D.

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ABSTRACT

Background Vitamin D deficiency is a major risk factor for bone loss and fracture. Although hypovitaminosis D has been detected frequently in elderly and housebound people, the prevalence of vitamin D deficiency among patients hospitalized on a general medical service is unknown.

Methods We assessed vitamin D intake, ultraviolet-light exposure, and risk factors for hypovitaminosis D and measured serum 25-hydroxyvitamin D, parathyroid hormone, and ionized calcium in 290 consecutive patients on a general medical ward.

Results A total of 164 patients (57 percent) were considered vitamin D–deficient (serum concentration of 25-hydroxyvitamin D, <15 ng per milliliter), of whom 65 (22 percent) were considered severely vitamin D–deficient (serum concentration of 25-hydroxyvitamin D, <8 ng per milliliter). Serum 25-hydroxyvitamin D concentrations were related inversely to parathyroid hormone concentrations. Lower vitamin D intake, less exposure to ultraviolet light, anticonvulsant-drug therapy, renal dialysis, nephrotic syndrome, hypertension, diabetes mellitus, winter season, higher serum concentrations of parathyroid hormone and alkaline phosphatase, and lower serum concentrations of ionized calcium and albumin were significant univariate predictors of hypovitaminosis D. Sixty-six percent of the patients who consumed less than the recommended daily amount of vitamin D and 37 percent of the patients with intakes above the recommended daily amount were vitamin D–deficient. Inadequate vitamin D intake, winter season, and housebound status were independent predictors of hypovitaminosis D in a multivariate model. In a subgroup of 77 patients less than 65 years of age without known risk factors for hypovitaminosis D, the prevalence of vitamin D deficiency was 42 percent.

Conclusions Hypovitaminosis D is common in general medical inpatients, including those with vitamin D intakes exceeding the recommended daily amount and those without apparent risk factors for vitamin D deficiency.


Source Information

From the Endocrine Unit (M.K.T., D.J.D., J.S.F.), Department of Medicine (D.M.L.-J., R.I.T., A.C.S., B.T.K.), and the Department of Pathology (E.C.V.), Massachusetts General Hospital and Harvard Medical School, Boston; and the Department of Medicine, University of Western Australia, Perth (I.M.D.), and the Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands (R.L.P.) — both in Australia.

Address reprint requests to Dr. Finkelstein at the Endocrine Unit, Bulfinch 327, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114.

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Related Letters:

Hypovitaminosis D in Medical Inpatients
Looker A. C., Gunter E. W., O'Shea D., Carter G. D., Finkelstein J. S., Thomas M. K.
Extract | Full Text  
N Engl J Med 1998; 339:344-346, Jul 30, 1998. Correspondence

Hypovitaminosis D in a Sunny Country
Fuleihan G. E.-H., Deeb M.
Extract | Full Text  
N Engl J Med 1999; 340:1840-1841, Jun 10, 1999. Correspondence

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